title: Alcohol drinking and liver cancer risk: an evaluation based on a systematic review of epidemiologic evidence among the Japanese population.
abstract: BACKGROUND
  Although alcohol consumption has been recognized as a risk factor for primary liver cancer, it will be informative to summarize relevant epidemiologic data in the Japanese who have characteristic environmental determinants (e.g. hepatitis C virus infection) and genetic traits (e.g. presence of poor acetaldehyde metabolizers).
  
  
  METHODS
  We systematically reviewed epidemiologic studies on alcohol drinking and liver cancer among Japanese populations. Original data were obtained through searches of the MEDLINE (PubMed) and Ichushi databases, complemented with manual searches. The evaluation was performed in terms of the magnitude of association ('strong', 'moderate', 'weak' or 'no association') in each study and the strength of evidence ('convincing', 'probable', 'possible' or 'insufficient'), together with biological plausibility as previously assessed by the International Agency for Research on Cancer.
  
  
  RESULTS
  Among 22 cohort studies identified, 14 (64%) reported weak to strong positive associations between alcohol and liver cancer risk, 3 (14%) reported no association and five (23%) reported weak to moderate inverse associations; such inverse associations were found mostly in follow-up studies of patients with chronic liver disease (particularly, cirrhotic patients), yet recent studies on patients with chronic hepatitis C presented fairly consistent positive associations. Of 24 case-control studies identified, 19 (79%) showed weak to strong positive associations, whereas the remainder demonstrated no association (n = 4) or a moderate inverse association (n = 1).
  
  
  CONCLUSIONS
  We conclude that there is 'convincing' evidence that alcohol drinking increases the risk of primary liver cancer among the Japanese population.
authors.affiliation: Department of Preventive Medicine, Faculty of Medicine, Saga University, Saga, Japan. tanakake@post.saga-med.ac.jp
authors.forename: Keitaro
authors.initials: K
authors.lastname: Tanaka
authors.forename: Ichiro
authors.initials: I
authors.lastname: Tsuji
authors.forename: Kenji
authors.initials: K
authors.lastname: Wakai
authors.forename: Chisato
authors.initials: C
authors.lastname: Nagata
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Mizoue
authors.forename: Manami
authors.initials: M
authors.lastname: Inoue
authors.forename: Shoichiro
authors.initials: S
authors.lastname: Tsugane
mesh_terms: D000428:Alcohol Drinking / Q000009:adverse effects* / Q000453:epidemiology*; D016022:Case-Control Studies; D015331:Cohort Studies; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008019:Life Style; D008113:Liver Neoplasms / Q000453:epidemiology* / Q000209:etiology*; D018570:Risk Assessment; D012307:Risk Factors